【摘要】 目的:编译脑卒中生活质量影响量表3.0代理人版本,考察中文版的信度、效度和反应度,探讨代理人代替患者测试生活质量的可行性。方法:①选择2003-06正在中山大学附属第一医院神经内科住院患者及其代理人10对,回访2002-06/09入院并住院患者及其代理人共231对,患者符合世界卫生组织脑卒中诊断标准,并经CT或MRI确诊;代理人认识患者至少1年。分别用于脑卒中生活质量影响量表3.0代理人版本中文版初试和正式测试。②应用59个条目(分属力气、记忆和思维、情绪、交流、日常活动能力、行动能力、手功能和社会参与8个方面)构成的脑卒中生活质量影响量表3.0代理人版中文版进行调查,另外,使用公认量表:健康状况调查问卷的中文版、Barthel指数、简明精神状态检查量表、汉密顿抑郁量表考察各个领域的标准效度;使用牛津残障评分作为分组(分4组:0～1,2,3,4～5分,分值越高,残疾程度越重)依据来考察脑卒中生活质量影响量表3.0代理人版本中文版的反应度。③使用量表完成率和完成时间考查初试量表的可行性;使用分半信度、克朗巴赫系数(α)考察信度;通过专家评审和测定维度相关系数考察内容效度,测定量表各个领域与公认量表(金标准)的相应领域的相关系数来考察标准效度、使用因子分析考察结构效度。通过比较不同残疾程度的患者的评分考察反应度。④分领域比较患者同代理人得分的差异,用配对t检验和测定组间相关系数评价代理人代替患者进行生活质量测定的可行性。结果:①可行性:量表完成率为91.2%;时间15～20min,表明可行性好。经专家讨论后,对部分条目进行了文化调试。②信度:分半信度和α系数均大于0.8。③效度:量表各条目与所属领域总分的相关系数>0.6,因子分析结果表明结构效度好;各领域与已知公认量表的相应领域高度相关(r=0.515～0.872,P<0.01)。④反应度:牛津残障评分分组下的单因素方差分析显示各组间得分不全相等(F=8.983～130.284,P<0.01)。⑤患者与代理人测试结果:患者和代理人脑卒中生活质量影响量表3.0得分比较,差异不明显(相关系数=0.757～0.964,P>0.05)。结论:脑卒中生活质量影响量表3.0代理人版中文版的信度、效度和反应度是满意的,用代理人代替患者进行生存质量研究是可行的。更多还原

【Abstract】 AIM: To translate the Stroke Impact Scale (SIS) 3.0 for proxy, test the reliability, responsiveness and validity of its Chinese version, and explore the feasibility of proxy to test the patients’ quality of life. METHODS: ①This study was leaded by the First Affiliated Hospital of Sun Yat-sen University. In primary test, ten patient-proxy pairs were randomly selected from patients in ward of Neurology Department in June 2003. In formal test, subjects of 231 pairs were recruited from hospitalized patients between June and September in 2002. They all accorded with the stroke criteria of World Health Organization, diagnosed by CT or MRI, and assessed with the Chinese version of SIS 3.0; Proxy were acquainted with patients for more than one year.②The Chinese version of SIS 3.0 for proxy was comprised of 59 items belonging to 8 domains (strength, memory and thinking, mood, communication, activities of daily living, mobility, hand function and social activity). We analyzed the standard validity of the Chinese version of SIS 3.0 for proxy with Medical Outcomes Study Short-Form 36 Health Survey, Barthel Index, Mini-Mental State Examination and Hamilton Depression Rating Scale. Oxford Handicap Scale (OHS) was used to investigate SIS 3.0 responsiveness, grouping by 0-1, 2, 3, 4-5 scores, the higher scores indicated the severer disability degree.③The average completion time and response rate were used to assess feasibility. Split-half reliability and Cronbach α coefficient were used to assess reliability. Content validity was assessed by specialists’ assessment and domain coefficient in statistical analysis. We used factor analysis to assess construct validity, while standard validity was tested with the correlation coefficient of SIS 3.0 and golden standard in each domain. Responsiveness was addressed by comparing mean scores for each domain to the groups defined by the OHS scores.④Comparison inter-domain was made between patients and their proxies using paired t-test and intraclass correlation coefficients (ICC) value to assess the validity in proxy assessment. RESULTS: ①Feasibility: The average completion time was 15-20 minutes with response rate of 91.2%, showed a good feasibility. Some items were conducted cultural assessment after the discussion of specialists.②Reliability: Both split-half reliability and α coefficient were more than 0.8.③Validity: SIS had a good content validity with correlation coefficient of more than 0.6. Construct validity was also good as indicated by factor analysis. Good criterion validity was established by comparing the scores on various domains to standardized measures (r =0.515-0.872, P < 0.01).④Responsiveness: Proxy scores were significantly different across OHS scales by one-factor analysis of variance (F =8.983-130.284, P < 0.01).⑤Comparison of patient and proxy responses resulted in no significant difference (ICC =0.757-0.964, P > 0.05). CONCLUSION: The psychometric properties (validity, reliability and responsiveness) of SIS 3.0 for proxy in Chinese version are satisfactory. It is feasible to use a proxy respondent to answer questions on the patient’s behalf.更多还原